Provider Demographics
NPI:1417517467
Name:PANSURIA, HIREN SHANTILAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:HIREN
Middle Name:SHANTILAL
Last Name:PANSURIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 DAISY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025
Mailing Address - Country:US
Mailing Address - Phone:201-546-0876
Mailing Address - Fax:
Practice Address - Street 1:312 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:PA
Practice Address - Zip Code:17842-1106
Practice Address - Country:US
Practice Address - Phone:570-837-5117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0421611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice